Active NPI
David A. Niederkohr, O.D.
- Optometrist
- Delaware, OH
National Provider Identifier
1366529844
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3260T1062
- Practice address
- 25 Northwood Dr
Delaware, OH 43015-1501 - Phone
- (740) 369-7701
- Fax
- (740) 369-0021
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3260T1062 | OH | Primary |
Addresses
Primary practice location
25 Northwood Dr
Delaware, OH 43015-1501
Mailing address
10197 Abbotts Way
Powell, OH 43065-6652
Phone (614) 785-9858
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000117913 | Other | ANTHEM BC/BS | |
| 17042 | Other | OH | SPECTERA |
| 311001012003 | Other | OH | MEDICAL MUTUAL |
| 3230 | Other | DAVIS VISION | |
| OH1062 | Other | OH | EYEMED |
| 0349813 | Medicaid | OH | |
| 0005353619 | Other | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3260 | OH | MD | Chiropractor |
| 3260T1062 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337644800000",
"number": "1366529844",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10197 ABBOTTS WAY",
"city": "POWELL",
"state": "OH",
"postal_code": "430656652",
"telephone_number": "614-785-9858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25 NORTHWOOD DR",
"city": "DELAWARE",
"state": "OH",
"postal_code": "430151501",
"telephone_number": "740-369-7701",
"fax_number": "740-369-0021"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIEDERKOHR",
"first_name": "DAVID",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2012-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3260T1062",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BC/BS",
"identifier": "000000117913",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECTERA",
"identifier": "17042",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL MUTUAL",
"identifier": "311001012003",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "3230",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EYEMED",
"identifier": "OH1062",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0349813",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0005353619",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Delaware, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.